Tag: chronic pain

As I mentioned in today’s garden post, I had an EMG (electromyogram) test this morning. This test was paired with an NCS (nerve conduction study) to measure possible nerve damage in my L4 root nerve. Long story short, I was mildly (and literally) shocked at points along this root nerve, from my feet to my lower back. Then the testing neurologist inserted an acupuncture-sized needle on some of those same points. This needle is equipped to measure the amount of electrical activity of the muscles at rest and contraction.

The speed and degree of electrical conduction can reveal whether a nerve is healthy, pinched, or damaged. During the EMG portion that uses the needles, the sound should be silent when a muscle is at rest. During my test, every point probed along the L4 root nerve produced static both at rest and during contraction. It was like listening to an AM radio in the desert where every station eludes reception.

Onto a small tangent, my husband told me that one of the treasured memories of his youth was tuning in the Wolfman Jack show broadcast from CKLW in Windsor, Ontario. I’m not sure what sort of voodoo he used to make this happen. This was no easy feat considering that he lived 240 miles south of that city at the time. In my left leg, it’s like the Wolfman Jack, Captain Beefheart, Casey Kasem and similar worthies have taken a permanent vacation.

Today’s electrical studies showed that my L4 root nerve has some permanent damage. The matter of when and how this happened is debatable. The neurologist told me that it is unlikely that last year’s spine surgery caused this damage because I had six good months of recovery afterward. This nerve endured some degree of compression for 10-15 years before the surgery. Now that I am having problems with an adjacent disc compressing this same nerve, the damage is more obvious.

At this time, there is no certain fix for this damage. A second surgery could relieve this pressure, but I would still have a damaged nerve. Another surgery would also present more risk than the first. This revelation makes me wonder if I unknowingly had a pointless first back surgery. Why in the world didn’t anyone order an EMG test before that surgery? How was it possible to get a spine surgery approved by insurance without such a test?

Before that surgery, I mainly had numbness along that nerve. Looking back, my pain before that surgery was much easier to endure than the flare-ups I have now. It’s like that lumbar fusion surgery awakened a beast that rages at the dying of its light whenever I stand in place for more than a few minutes at a time.

Life has ample opportunity for regret. Alas, I can’t time travel back to early 2017 and cancel that surgery. A part of me needs to believe that one is never in the wrong place at the wrong time, that we are exactly where we need to be right here, right now. It is possible that the need for a back surgery could have become urgent eventually. The longer I might have waited for that surgery, the worst the residual damage to the nerve would have been.

It still blows my mind that I lived in oblivion regarding my lumbar degeneration for more than a decade. That was a time when I could let nothing hold me back, and I was better off striving in ignorance. If I had known about this damage, I don’t think I would have even tried to have the life that I have now.

When I think of this oblivion, I recall JFK’s well-known words about the goal of reaching the moon:

We choose to go to the Moon! We choose to go to the Moon in this decade and do the other things, not because they are easy, but because they are hard; because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one we intend to win, and the others, too. (found here)

Creating a self-supporting life for my daughter and me has been my moon shot. While I have been married for a couple years now and have a husband who is a great help to me, it was essential to me that I learn to make it on my own. For five years, my daughter and I lived by ourselves, and we were self-supporting. This was no easy feat.

I face mental and physical adversity that could have made this impossible had I stopped long enough to consider it. Here’s what my MMPI results were when I started my personal moon shot:

That evaluation was courtesy of the Ohio Bureau of Vocational Rehabilitation. I qualified for BVR services, but I did not pursue the plan they created for me because I would run out of welfare benefits before I finished the additional education and training needed to create a career that accommodated my disability well (and Social Security had denied my disability claim because I hadn’t given “unskilled” labor a try (Wtf?)).

So I signed up for an office temp service and prayed that I’d land in a position that could keep a roof over my and my daughter’s head. Thank God it happened! I blindly began the job I have now, thinking it was a steady data entry desk job. When I arrived, I discovered that I’d be walking through a half-million square foot facility to collect much of the data I entered.

No job is perfect and constantly loved (in that way, I suppose jobs are like people), but my job is fairly ideal for me. I never tire of the mystery of finding a pallet that seems to have sprouted legs and left the building. Or why in the world do we have cases that expire on May 36th?

If I had known how damaged my back was, it is possible that I wouldn’t have tried such things. It is true that I continue adjusting to my nerve pain, but at least I know that I am living a life I have proven is not impossible for me.

Below shows how many steps I walked last week:

Perhaps I am grating cheese to say the following, but I will endure this road, even though I have moments that are harder than I could have imagined they’d be. I still choose to go the moon. I’m loving this metaphor a bit too much, but there are plenty of moon shots ahead of me, even if I have to sit in a chair part of the time to make it there.

Like this:

I scheduled a day off work today due to an EMG (electromyogram) test scheduled for this morning. The test was only minimally painful, which was a pleasant surprise. One doesn’t expect the sensation of electric shock to be merely inconvenient. The strongest charges did provoke a tiny rush of adrenaline, which I suppose was my body’s way of reminding me that shock is something to avoid.

More on the EMG in a later post . . .

I had some time to take a few photos of the garden. I love the May sunshine, how it offers a warmth that is not yet oppressive. It’s something I long for a bit all year.

Spring is well into its eruption of green and blooms. Once again, it’s been entirely too long since I last posted. I actually took these photos a fortnight ago, but I haven’t gathered the will or candor to post them until now. The previous sentence begs the question of why should honesty enter the equation of creating a blog post with nature photos? This oddity arises because this blog is also an open diary of sorts, and I feel that failing to disclose parts of my ongoing problems would be a lie of omission.

I continue to struggle with chronic pain, and I suspect that I have partly alienated key people in my life with my complaints about it. I can take enough of their perspective to understand why some people just look at me with stone-still faces as I talk about my nerve pain or migraines. They can’t solve this problem for me. Nerve damage is not something that can be fixed like a flat tire.

There’s also something to be said about the notion that thinking about pain is not helpful. I don’t think it’s possible to talk about pain without thinking about it. Reflecting on pain can intensify the sensation of it. Perhaps my conversations about pain tend to become monologues because people might think being supportive of my talking about pain will lead to me thinking more about it and hurting more. There’s an innocence beneath such a perspective. You are lucky if you’ve never felt pain so omnipresent that it could not be ignored. Since I think of lyrics entirely too often, this sort of aforementioned innocence reminds of some lines from “These Days” by the Foo Fighters: “Easy for you to say . . . your pride has never been stolen.”

Speaking of lyrics, the borrowed the title of this post hails from “Goodnight Song” by Tears for Fears. There are bits of treasure to be gleaned from pop culture.

Another gem I remembered this week hails from “I Wish You Well” by Tom Cochrane (who, btw, also wrote “Life is a Highway”): “She wants her space to feel love and be angry.” I’m still angry that pain erupts in me every single day, like a toddler who tantrums again and again for toys that might have been bought if not for the fit thrown. There are few certainties in life aside from birth, death, and change. I’m mad because I don’t want my life to change.

I loved the character and substance of my days in the decade before this mess happened. I loved that I had become a morning person, that I had conquered my fatness (a problem which has returned btw, but not entirely). I loved binge-watching British mystery shows while riding an exercise bike or elliptical machine for the entirety of a series (I’d watch the show for 30 to 45 minutes at a time). I loved my small feats of strength, such as carrying the better part of a trunkload of groceries in one trip.

I’m beginning to consider that the sort of life I was leading was both a denial and intuitive treatment of spinal issues that had been brewing for years before their diagnosis. Weight loss is a good conservative treatment for spinal degeneration. Losing 130 pounds did make me feel better, but all the while I ignored important signs. It is not normal to awaken five nights a week due to leg cramps. It is not ordinary at all for weight loss to restore sensation to a knee that was apt to go numb when doing any significant standing or walking. This era of my life now seems to be an extended remix of the sort of denial that can lead a woman to fail to realize she is pregnant until she is in labor. Wasn’t there a show about this phenomenon called I Didn’t Know I Was Pregnant? I remember seeing an episode of this series wherein one of the women said she was mystified by pains that were “growing stronger and longer and closer together,” until her baby crowned.

I recall laughing heartily over that woman’s surprise childbirth story. I thought, holy shit, how can you be of childbearing age and not equate pain that gets stronger, longer, and closer together with labor? I now know that life is full of such willful ignorance. We bury all sorts of deception and pain until we’re ready to deal with it. There are times when we’d rather not add up signs of betrayal or know what that pain means. We don’t want to stop just yet and open the door to that which must be reckoned with eventually.

I’m lost in charting a course in how I must change to cope with my chronic pain. Should I pursue a cure when some of my previous attempts seemed to be worse than the disease? I belong to a Facebook group for people who’ve had spinal fusion surgery. I’ve noticed that many members have written that spinal fusion surgery was the most painful experience of their lives. In all honesty, I didn’t think it was exceptionally painful compared to other surgeries I’ve had. Actually, there have been times every day this week that I have felt worse than I did in the days after that surgery.

I suppose it doesn’t help that my affect is rather flat through all this. My Midwestern stoicism is very deeply ingrained in me; I seldom look stricken when I’m in pain. I suppose that it is hard to believe me when I mention that today I felt worse than when I was in labor with my daughter, even if that is a true statement (and I had back labor for 44 hours, half of which I endured with no pain medicine).

Here are the diagnoses on my chart at my family’s doctor’s office:

There are several chronically painful conditions on that list.

My chart at the local orthopedic center has a bit more detail:

I don’t know how I could keep this mess to myself, to spare people the details and reality of such pain, without being a fundamentally dishonest person. I am the sort of person who has almost no mental real estate for keeping secrets, and all of that space is reserved for secrets that belong to other people.

Lately, I’ve heard that I must be blowing this struggle out of proportion, for I’ve been through worse in the past. For example, people will mention that it must have been harder to leave everything behind but a couple suitcases when my daughter and I relocated 2,000 miles away during her infancy. I assure you, dear reader, that my past struggles were very easy indeed compared to what I face now. Nothing is easier than quitting, no matter what the consequences of doing so. Through quitting, you take the power of choosing the outcome, even if the result is awful. Quitting is not an option now. I must bend without breaking to keep everything in place, no matter how bad I’m feeling.

I will close this post with images of this season’s enfolding growth, and I hope that my mind, body, and spirit begin to reflect this renewal.

I’ve had yet another lengthy flare-up of nerve pain. I waited to write because, really, what is the point of peeling that onion of anger and frustration once again? It’s not like this nerve pain recedes completely. It’s been a faithful visitor to me for decades (since age 11). Its visits have become frequent and longer lasting over the years, especially in the past year and a half, with the exception of the six month period immediately following my spine surgery. I had minimal nerve pain during those six months. It’s possible that I lost of bit of my “tolerance” for this pain during those six months, kind of like how one needs to get acclimated to cold all over again at the beginning of winter. Still, you’d think I’d have built that tolerance back by now.

It’s becoming clearer to me that I may not find an answer or a ready narrative for my pain. I recently read a book called Drug Dealer, MD by Anne Lembke, MD (Johns Hopkins Press). While this volume is really a textbook for college classes addressing the opiate crisis, it did have some concepts I found very helpful to my situation. Lembke stresses that story creation is a fundamental part of both culture and identity. Like every culture, mine has common stories about illness, about pain. There’s a good chance I’m going to pursue one or more those stories to get relief, and the doctors who have treated me and will treat me have their own stories.

I feel lucky that one particular story was not available to me: long-term opiate therapy. Had I gotten surgery for my ruptured L4/L5 disc earlier in time (and my disc ruptured many years ago, unbeknownst to me, actually), this may have turned out differently. I think it was a bad collision of opportunism on one side and compassion on the other that lead to a whole generation of back pain patients getting hooked on opiates. No one can convince me that opiates work long-term at safe doses, and I don’t think they help with nerve pain. There’s also the proverbial elephant in the room, or the colon, if you will, constipation. Why in the world in the world would I want to lay a pile of bricks and mortar on top of the mess I’ve already got going on down there?

I used the term back pain the preceding paragraph, but that is also a source of contention for me. In reality, I don’t often have back pain, and when I do, it quickly resolves itself. No matter how many times I’ve tried to correct the matter in the past and present tense, my appointment records and the like still indicate that I have back pain. Is there is just no diagnostic category for what ails me? I have spinal stenosis, assorted bad discs, and the like. I have radicular nerve pain that is intermittent and moderate to severe when it flares up. Years ago I saw an electrical storm from a highway in the New Mexico desert. The nerve pain feels like that storm looked.

The pain seems to be a function in part of the pace of my movement. This is most evident when I am walking. Slow walking or waiting in line can be an agony to me, but faster walking usually gives me no trouble. Why is it that I can walk miles in a day but I can’t stand in place for more than a couple minutes?

This is the moment when I recall something that my sister, who is a fellow nerve pain/spinal stenosis patient, used to say to me in the midst of our various sibling rivalries, “Nobody knows and nobody cares.”

That may sound radically cynical, but there’s a vital truth in it for chronic pain patients: you are chronic because nobody yet knows how to fix your pain, and if they do not care, do not go back.

I don’t know where to turn next for getting treatment for this nerve pain. The first thing I’ve learned is that any treatment can have unintended consequences. When I had L4/L5 fusion with disc replacement last year, the indication was advanced disc degeneration and severe spinal stenosis. I had significant numbness in my left leg, urinary issues, and the like. I did have sciatica in the months leading up the surgery, but nothing as troubling as the nerve pain I’ve felt in the past nine months.

Long story short, surgery was the treatment of choice for what ailed me. I knew that the discs above the one replaced were not in great shape, but I did not think they would give me trouble so quickly. By the way, despite the nerve pain L3/L4 is generating, it is nowhere near qualifying for surgical removal. The one that did get removed, L4/L5, was so herniated it compressed my spinal cord on one side. It remains a mystery to me why it took so many years for me to feel pain or other symptoms from the L4/L5 rupture.

Next, I had the epidural injection. I wasn’t thrilled with this treatment. The relief I had was partial, and it lasted for six weeks. After this injection, I had nerve pain in new locations like my toes and neck. When the L3/L4 returned, it was mirrored to the right side, too. Now I have nerve pain in all four quadrants of my body. I cannot claim a cause-and-effect relationship here, but I will tell you to be very careful when you open the proverbial Pandora’s box of the central nervous system, especially if you come from a family with a history of migraine or fibromyalgia as I do. It’s not that I feel more pain than I did before I had the epidural; it’s coming from many more locations than it did before.

Back to the concept of story, I suppose it’s up to me to craft one of my own that helps me makes sense of what’s changed within me, one that does not rely on scalpels, syringes, or prescription drugs. We were human long before there were any cures. We loved, suffered, and triumphed before we knew what ailed us.

Our first snow of the season is falling outside, an inch-deep Alberta Clipper. I am long past the cozy enchantment of anticipating snow drifts and the like. I’d rather watch it through the safe distance of film or video than experience it firsthand.

I’ve refrained from writing posts for the past couple weeks because I thought that doing so would be akin to pouring salt on a wound. Now that the worst of the nerve pain that plagued me through late summer to mid-November seems to be behind me, I have been quite angry over what happened. I am mad that I waited so long for relief (which, by the way, came randomly with the pulling of a heavy drawer while bent over at an awkward angle).

I am not exaggerating when I say that this interlude of nerve pain was the worst thing that has ever happened to me. Maybe there is something in the nature of pain that inclines a person to believe that the latest acute episode is the worst one, sort of a photo negative of one’s love life, how often we hear that a person’s current lover is the best one ever. With that aside, I will tell that I really did feel worse than I ever had.

I am no stranger to pain. I had a radical mastoidectomy, wherein a damaged part of the skull that borders the ear is removed. I was in labor for 44 hours when I had my daughter, and I had no pain medication for 24 out of those 44 hours (and this was back labor). I would add this year’s spinal fusion surgery to this list, but the pain of that procedure and its recovery were nowhere near as bad the preceding two events in this paragraph.

I know that there are millions, if not billions, of people in this world who’ve lived through pain far worse than I have. I can only attest to my own pain, and I am mad when I think of all the effort I devoted to finding a resolution to my recent pain. I don’t think I was taken seriously because I could still walk on my own and keep a straight face while doing so.

It must be hard for orthopedic doctors to understand that the pain of a patient who can work and communicate as normal can be important. In any given day or week, they see patients who’ve been broken through traumatic accidents, people who arrive for their appointments in a wheelchair or on a stretcher. So when someone like me comes knocking, a patient who seems to walk with apparent ease and can report their symptoms in a near-clinical tone, they must be tempted to assume that such a patient is just worried but well. I was not.

After three months of asking for an explanation for why I suddenly felt so bad six months past my surgery, I learned a few things through an MRI and physical examinations. I am healing well from my L4/L5 fusion surgery. This does not surprise me because the pattern of my nerve pain was markedly different than what I experienced in the months leading up my surgery. Back then, I had numbness in my left knee and part of my foot, with flares of sciatic pain that struck at random. This time around, I had awful nerve pain in a band from my outer left hip to the inside of my left knee, only when I stood in place for more than a few minutes or walked more than a hundred yards or so.

It turns out that my L2/L3 and L3/L4 discs have degenerated more in the past year, but neither are in bad enough shape to qualify for more than conservative treatment measures. I also have bursitis in my hip and strain in a tendon that leads from my hip to my knee (ITBS, or iliotibial band syndrome). I’ve been doing physical therapy exercises for the bursitis and ITBS, but the aches and pains of those issues aren’t completely gone.

I do not yet have clarity on what I can do to prevent further flare-ups of nerve pain. No one has offered me a prognosis or definitive reason for why my orthopedic problems continue. Last year, I heard that my lumbar degeneration is hereditary. This makes sense given that I have several close relatives with similar problems. However, there isn’t enough similarity between our symptoms and course of disease to model a course of action based on what has worked for the others.

I wish I knew if I there was something I am unwittingly doing that could be making things worse, that some qualified person could take me in hand and tell me that I should change my life in such-and-such ways because of my spinal stenosis. It seems I must draw that map myself.

I don’t think I have accurately conveyed how active I must be to lead the life that I do. Both my job and my life at home require all sorts of walking. Below is a chart of all the walking I’ve done since my surgery in March (from my Fitbit account, btw):

I’ve discovered through long experience that the only sure thing that keeps my depression at bay is walking. I thank God that the chief prescription for my surgical recovery was walking. What would I do if my spinal stenosis progressed to the point when I couldn’t walk much at all? I’d practically need to remake myself.

I’ve watched far too many episodes of Agatha Christie’s Poirot lately. There was something Poirot said in the episode called “Appointment with Death” that is one of the most inspirational things I’ve ever heard:

“There is nothing in the world so damaged that it cannot be repaired by the hand of almighty God.”

Around 11 last night, it started raining hard enough to turn all the pipes on the roof into little dissonant steel drums. My sense of what keeps a house from surrendering to noxious fluids and vapors is vague at best. It’s only during a hard rain that I know for certain where the all the exhaust vents emerge atop the house.

I awoke to the sounds of the same hard rain this morning. I’ve already done the dishes, started the laundry, and done some basic grocery shopping this morning. I really should fold the clothes. When the dryer starts dinging, it’s like a siren call of domestic duty–fold me now, lest you need to dust off the dreaded iron.

I will resist that call in favor of writing a bit. I don’t think there’s anything in that dryer that can’t be unwrinkled with a few minutes of fluffing.

I suppose it’s a cardinal sign of self-absorption to the start several paragraphs in a row with the word I. Indeed this post focuses on me and my recent struggles.

In sharing these problems, I hope that I am not merely alienating my readers. It is not impossible that some of you have endured the same or similar trials. If that is the case for you, I hope you find some solace in seeing a kindred spirit emerge from similar adversity.

I am just arising from flare-ups of chronic pain and depression that spanned three months. It began with hip pain and ended with the worst variant of sciatica that I’ve ever had the misfortune of feeling.

I did have a few random days I felt no pain at all. All the while, I had no pain unless I was moving. To feel no pain at rest is a blessing ordinarily taken for granted. I recently joined a Facebook support group for people who’ve had spinal fusion surgery. My first impression was how fortunate I am among that cohort of patients. Compared to that group of patients, my burden is light. I don’t struggle to sleep because of pain. I can work.

Here is the thing I gleaned from reading those stories: The only pain you know is your own, and it should not be discounted just because someone else has suffered more. There were moments of my most recent sciatica episode that afforded me the worst pain I’ve ever felt. It’s a pain that does not season you pleasantly with wisdom or humility. Instead, it just makes you bitter that it happened, a rude surprise that you still had a little innocence left to steal.

It all ended with a moment akin to the last bolt of lightning that flashes at the end of a storm. I was putting away laundry and leaned over to open one of my clothes drawers, a drawer that is heavy with clothes that need pruning. I felt rushed (for no good reason) to finish the laundry, so I stayed bent over at the same awkward angle as I closed the drawer. As I pushed it closed, I felt a bizarre stretching in my lower back, and the ends of my spinal fusion felt like they were sparking with a bit of heat.

I straightened myself out, dreading that I might have complicated hereditary lumbar degeneration with a careless accident. As I walked down the hallway from my bedroom, I realized that something quite different had happened. My sciatica was gone. My awkward maneuver made a supremely lucky adjustment, one that I couldn’t repeat in a hundred tries.

I am still contending with the ordinary legacy of ongoing recovery from my spinal fusion surgery, which presents a random array of numbness and nerve pains. It is a calm I’ve not known for long since the height of summer.

I’m devoting this time before the holiday rush to some deeper rest. I’ve been digging into some Agatha Christie stories, both in print and on television. Actually, Agatha Christie is an author I willfully ignored until now, dismissing her body of work as trite without having read a line of her work. I’ve been pleasantly surprised at how witty and sometimes bawdy her prose can be. The stories I’ve read and seen on screen are reminders that the moral compass of humanity isn’t degenerating more with each succeeding generation. The good and bad have always existed, only the fashions and technology have changed.

I’ve been pleasantly surprised at how witty and sometimes bawdy her prose can be. The stories I’ve read and seen on screen are reminders that the moral compass of humanity isn’t degenerating more with each succeeding generation. The good and bad have always existed; only the fashions and technology have changed.

With that written, I will now attend to folding the laundry, avoiding any foolish haste with the pushing and pulling of drawers.

Like this:

I decided to use a benign floral image for this post rather than recycle one of my x-rays. That photo reminds me that there is truth, beauty, and comfort to be found in places outside myself. Right now I find little solace on the inside.

I am still contending with orthopedic pain that is trending toward chronic pain. More of my problems have been revealed through recent doctor visits. All of these issues are just different facets of the same stone, but the substance of this stone resists identification.

My lumbar spine issues were partially resolved through the L4/L5 fusion surgery I had back in March. When I look at my orthopedic visit summaries, I don’t like that diagnoses like “lumbar spinal stenosis” and “radiculopathy” are marked as resolved, as if my surgery totally alleviated those issues. In truth, the surgery repaired my worst disc space, but I have three more problematic discs. My MRI from December of last year revealed that I had four bulging or ruptured discs in my lumbar spine. The degree of deterioration between L4/L5 was far advanced compared to the other discs, so it was chosen for surgical intervention.

My recovery was progressing better than expected until August when the pain I used to feel while standing in place came roaring back worse than I’d ever felt in the past. This is admittedly a strange problem: when I am resting or walking quickly, the pain I feel is minimal or nonexistent. Moving slowly or standing in place becomes very painful within a couple minutes. We’ve all known the mental agony of waiting. It’s like this pain is that torment made physically manifest.

This disappointing development is odd considering that the serial x-rays after my fusion show that the area is healing and fusing well. My spinal surgeon referred me to another doctor in the orthopedic practice, one who focuses on hip and knee problems. The hip/knee doctor diagnosed me with (and this is a mouthful, admittedly) iliotibial band syndrome with sartorial strain. He prescribed physical therapy for this problem.

The exercises I learned in my PT sessions have helped resolve much of the tension I was feeling in my left leg, but my pain I feel while standing in place or walking slowly has not diminished.

I had a follow-up appointment with the hip/knee doctor today. He considered my complaints and carefully reviewed my pelvic x-rays. He told me that I have arthritis in my left sacroiliac joint, where my spine joins my pelvis. I’ve started a prednisone dose pack to reduce the inflammation in the joint. If these pills do not substantially reduce my pain, it is likely that I will get getting a cortisone shot directly in that joint (guided by x-ray for proper placement).

It so happens that the hip/knee doctor has also had spinal fusion surgery, and he told me that he also has arthritis in that joint and has had such injections twice. When he revealed this information to me, I silently wondered why he didn’t mention this history during my visit last month. It would have stopped me from dreadfully speculating that my pain while standing was due to another ruptured disc. Really, I spent too much time considering that lumbar degeneration could follow a trajectory similar to that archaic domino theory of communism.

Apparently, there is something of a domino issue going on with my arthritis. I have extensive arthritis in my lumbar spine. That my spinal arthritis has been developing silently and painlessly for years seems proof of divine mercy in my life. Now that this arthritis has spread to an adjacent joint, the pain at that spot definitely has volume.

All of this static has occupied much of my mental space lately. I suppose there is a bizarre happy medium of suffering. A life free of adversity would be tasteless, its beauty as shallow as a polyester pantsuit, pleasing and wrinkle-free only from a distance. There must be a point of saturation for pain. Once this point is crossed, there is no eloquence, poetry, or melody. Life condenses to necessity, and the challenge is to keep from turning inward, for that is where pain reigns as long as it rages.